Case Report
A 53-year-old Spanish speaking female with a past medical history of
Rheumatoid Arthritis/Systemic Lupus Erythematosus (RA/SLE) Overlap
Syndrome with subsequent chronic polyarthritis presented to the
emergency room after routine labs showed severe anemia (Initial Labs:
Table 1). The patient had previous episodes of autoimmune-hemolytic
anemia resulting in hemoglobin levels of 4.0 mg/dl or lower. Therapy at
the time of evaluation included prednisone 5 mg every other day at home,
methotrexate 200 mg/week, and folic acid 1 mg daily to treat RA/SLE
overlap syndrome. She reported increasing fatigue over the past few days
without joint pain, cough, fever, chills, or any other constitutional
symptoms; however, she noted recent weight loss.
Notably, the patient had a positive interferon gamma release assay
([IGRA], QuantiFERON Gold) screening two years prior (Table 2) that
had not been addressed. The patient immigrated from Honduras, a
tuberculosis (TB)-endemic region, three years prior. She did not recall
having received vaccination against TB nor ever receiving therapy for
latent TB infection. She had no previous incarcerations, or
hospitalizations related to tuberculosis.